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INTRODUCTION

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Humans live in a chemical world.* They inhale, ingest, and absorb through the skin many of these chemicals. The occupational-­environmental toxicologist is primarily concerned with adverse effects in humans resulting from exposure to chemicals encountered at work or in the general environment. In clinical practice, the occupational-environmental toxicologist must identify and treat the adverse health effects of these exposures. In addition, the trained occupational-environmental toxicologist will be called upon to assess and identify hazards associated with ­chemicals used in the workplace or introduced into the human environment.

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Occupational and environmental toxicology cases present unusually complex problems. Occupational and environmental exposure is rarely limited to a single type of molecule. Most workplace or environmental materials are compounds or mixtures, and the ingredients are often poorly described in the documentation that is available for physician review. Moreover, although regulatory agencies in many countries have requirements for disclosure of hazardous materials and their health impacts, proprietary information exclusions often make it difficult for those who treat occupationally and environmentally poisoned patients to understand the nature and scope of the presenting illness. Because many of these illnesses have long latency periods before they become manifest, it is often a matter of detective work, when patients finally present with disease, to ascertain exposure and relate it to clinical effect. Monitoring of exposure concentrations both in the workplace and in the general environment has become more common, but it is far from widespread, and so it is often very difficult to establish the extent of exposure, its duration, and its dose rate when this information is critical to the identification of the toxic disorder and its management.

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Occupational Toxicology

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Occupational toxicology deals with the chemicals found in the workplace. The major emphasis of occupational toxicology is to identify the agents of concern, identify the acute and chronic diseases that they cause, define the conditions under which they may be used safely, and prevent absorption of harmful amounts of these chemicals. The occupational toxicologist will also be called upon to treat the diseases caused by these chemicals if he or she is a physician. Occupational toxicologists may also define and carry out programs for the surveillance of exposed workers and the environment in which they work. They frequently work hand in hand with occupational hygienists, certified safety professionals, and occupational health nurses in their activities.

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Regulatory limits and voluntary guidelines have been elaborated to establish safe ambient air concentrations for many chemicals found in the workplace. Governmental and supragovernmental bodies throughout the world have generated workplace health and safety rules, including short- and long-term exposure limits for workers. These permissible exposure limits (PELs) have the power of law in the United States. Copies of the U.S. Occupational Safety and Health Administration (OSHA) standards may be found on OSHA’s website at http://www.osha.gov. Copies of the U.S. Mine Safety and Health Administration (MSHA) standards may be ...

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